In 2025, the World Health Organization specifically called for action to address the epidemics of chronic kidney disease of undetermined etiology (CKDu) occurring in low-income agricultural settings as part of a wider resolution aimed at promoting kidney health to reduce the global burden of non-communicable disease. Despite this high-level recognition of the problem and two decades of research efforts there continues to be much debate surrounding the primary etiology of disease. Furthermore, there remain other unknowns in the CKDu field, including the spectrum of kidney conditions that this term includes and the geographical extent of disease.